Tag Archives: hypertension

Relationship between obesity and psychosocial risk factors in hypertensive patients

DOI: 10.2478/amma-2021-0030

Introduction: Unhealthy lifestyle habits, including sedentary behaviour and improper diet are major risk factors for obesity. Overweight is very frequent in hypertensive and type 2 diabetic patients. Psychosocial factors are associated with multiple health behaviors related to overweight/obesity. The aim of the study was to evaluate the relationship between obesity and psychosocial risk factors in hypertensive patients having different levels of education.
Material and methods: 623 hypertensive patients, admitted to the Cardiovascular Rehabilitation Clinic in Tîrgu Mureș were evaluated by weight, height, waist circumference, laboratory analyses and psychosocial risk based on a validated questionnaire on nine topics. Non-paired Student t test was used for statistical evaluation of the obtained data.
Results: Obesity or overweight affected 86.9% of the studied hypertensive patients. Obesity was more frequent in subjects having type 2 diabetes as comorbidity. Mean BMI was significantly higher in the lower education group (p=0.007) compared to those with higher level of education. Average triglyceride and uric acid levels were significantly higher in obese subjects compared to those having lower BMI (p<0.0001). Patients living alone had significantly lower mean BMI (p=0.006) and waist circumference values (p=0.001) compared to those living with their spouse.
Conclusions: Weight excess in very frequent in the studied hypertensive patients, especially in those with type 2 diabetes as comorbidity and having lower educational level. Hypertriglyceridemia and hyperuricemia occurred more frequently in obese subjects compared to non-obese ones. Overweight is less frequent in patients living alone.

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The Importance of Home Versus 24-Hour Ambulatory Blood Pressure Monitoring and Assessment of Blood Pressure Variability in Hypertension

DOI: 10.1515/amma-2016-0020

Background: A number of studies reveal that home blood pressure variability is associated with cardiovascular risk factors. However, we do not have a consensus regarding the variability index and the frequency of measurements.
Objective: The aim of the study was to assess home blood pressure variability for a period of 7 consecutive days and 24-hour ambulatory blood pressure variability using the average real variability index and to test whether home blood pressure variability represents a suitable parameter for long-term monitoring of the hypertensive patients.
Material and methods: A number of 31 hypertensive patients were included in the study, 8 male, 23 female, mean age 60.19±7.35 years. At the inclusion ambulatory blood pressure monitoring was performed, home blood pressure monitoring was carried out for 7 consecutive days with 2 measurements daily. We compared ambulatory blood pressure values, variability using paired t-test. We were looking for correlations between HBP values and cardiovascular risk factors.
Results: Ambulatory versus home blood pressure derived mean blood pressure was 131.38±15.2 versus 131.93±8.25, p=0.81. Ambulatory derived variability was 10.65±2.05 versus home variability 10.56±4.83, p=0.91. Home versus ambulatory pulse pressure was 51.8± 9.06 mmHg vs. 54.9±11.9 mmHg, p=0.046. We found positive correlation between HBPV and home BP values, p=0.027, r2=0.1577, (CI: 0.04967 to 0.6588). Home, as well as ambulatory derived variability were positively correlated to age p=0.043, r2=0.1377 (CI: 0.01234 to 0.6451) versus p<0.0001, CI: 0.3870 to 0.8220, r2=0.4302.
Conclusion: Assessment of home blood pressure monitoring and variability could represent a well-tolerated alternative for long-term follow-up of hypertension management.

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Blood Pressure Control Rates in a Cardiovascular Preventive Ambulatory System 2002–2010

Introduction: Increasing awareness, treatment and control rates of hypertensive patients is a worldwide problem especially in Central and East European countries.
The objective of the study was to determine the yearly changes in the achievement of treatment targets according to ESC 2003–2007 guidelines for the management of arterial hypertension in a preventive profiled ambulatory cardiology setting.
Patients and method: The study included 6591 hypertensive patients examined between 2002–2010 in the Procardia preventive ambulatory in Târgu Mureș, Romania. The sex distribution of the studied patients was 45.64% male average age 57.45 years, and 54.36% female average age 61.28 years. Patients received individually tailored self control education, lifestyle advice and drug treatment – the primary care providers were informed in detailed medical reports. We studied the yearly achievement of target blood pressure levels. We also analysed the frequency of investigations carried out for the global risk assessment screening for subclinical organ damage. We used “MedPrax” integrated patient data management system as an electronic health record. Statistical analysis was performed with the Open Office Calc programme.
Results: Target blood pressure values (under 140/90 mmHg in non diabetic patients and 130/80 in diabetic patients) were reached in 27.51%. The percentage of patients treated to target increased progressively from 15.25% to 36.29%.
Conclusions: The activity of the studied cardiology ambulatory setting provided a yearly increase in the level of blood pressure target achievement. Further improvement measures are needed to increase blood pressure control rates, with a specific attention to the diabetic patients.

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Traditional Risk Factors in Hypertensive Women and Men with Ischemic Heart Disease

Background: Ischemic heart disease is the main cause of morbidity and mortality in Europe. It occurs often in women, and its prevalence increases with age. Hypertensive patients with coronary heart disease are at highest risk and thus are the most important target of secondary prevention strategies. The purpose of this study was the identification of traditional cardiovascular risk factors in group of patients with known cardiovascular disease.
Material and methods: One hundred seventy-six patients took part in this cross -sectional study, which included 72 women and 104 men. Statistical analysis was performed with Microsoft Excel and SPSS 17 Programs.
Results: The average age of the patients was 66 for women and 68 for men. Obesity (BMI >30) was found more among women. We haven’t found statistically significant differences between the sexes regarding lipid profile, this being a common risk factor for both men and women. New cases of diabetes have been discovered in 19%.
Conclusions: Traditonal cardiovascular risk factors are present both in women and men with hypertension and ischemic heart disease.The target levels for lipids suggested by secondary prevention guides are not achieved by a large number of patients.

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Association Between Angiotensin Converting Enzyme Gene Insertion (I)/Deletion (D) Polymorphism and Secondary Arterial Hypertension in a Romanian Children Population

Introduction: Arterial hypertension is defined as systolic or diastolic blood pressure measurements higher than 95 age-gender-height percentile of the adopted reference values. Angiotensin-converting enzyme (ACE) is a component of renin-angiotensin system. ACE insertion/deletion (I/D) gene polymorphisms have been associated with the risk of various cardiovascular anomalies.
Aim: The purpose of our study was to assess the possible association of ACE I/D polymorphism gene and secondary hypertension in children.
Material and method: We genotyped 40 healthy and 38 hypertensive children and adolescents. The ACE I//D gene polymorphism was determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism technique utilizing specific primers. We compared the distribution of ACE I/D genotypes in the two study groups.
Results: The results of the study showed that the frequency of I/D ACE genotype distribution in patients with hypertension (DD = 18.42%,
ID = 68.42%, II = 13.16%) did differ significantly from genotype distribution in controls (DD = 47.5%, ID = 42.5%, II = 10%), and the DD genotype was not associated with secondary hypertension.
Conclusion: In conclusion we demonstrate that ACE gene polymorphisms are genetic markers for secondary arterial hypertension in children.

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Reducing Global Risk of Ambulatory Assisted Hypertensive Patients – What Could Be Changed in the Practice of a Romanian Preventive Ambulatory System According to New Dyslipidaemia Guidelines?

Reducing the total cardiovascular risk of hypertensive patients is one of the basic targets in hypertension management. A good lipid control is a major contributor of the global risk reduction.
Purpose: To simulate the impact of the ESC/EAS 2011 guidelines for the management of dyslipidaemias on the lipid management practice of a preventive profiled ambulatory cardiology system.
Methods: The study included all the 7413 hypertensive patients examined between 2002–2011 in a preventive ambulatory system. As a part of the simulation patients were stratified to risk categories according to ESC 2011 guidelines. We compared the frequency of prescribed cholesterol lowering medication with that theoretically indicated based on the new guidelines. The study is based on a retrospective simulation of the theoretical effects of the implementation of the new guidelines in a real patient population.
Results: Risk stratification could be performed in 78.74% of the population. Patients were stratified to very high risk 74.82%, high risk 1.96%, moderate risk 8.66%, and low risk 14.56%. Cholesterol lowering treatment was prescribed for 39.58% of the patients. Very high risk patients were treated more frequently (48.8%), than high (37.0%), moderate (26.5%), or low (16.4%) risk patients. According to the new ESC guidelines theoretical indication for cholesterol lowering treatment has been for 52.07% (3860) of patients. The analysis of the yearly trends in prescribing cholesterol lowering drugs showed an increase from 0% in 2002 to 52.7% in 2011.
Conclusions: A yearly improving trend can be observed in the frequency of indicating cholesterol lowering drugs. The future implementation of the new guideline has the potential impact to assure cholesterol lowering medication indication for another 1980 patients in our sample.

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The Frequency of Adverse Prognostic Features Detected with Ambulatory Blood Pressure Monitoring in the Practice of a Preventive Ambulatory System from Tîrgu Mureș

Background: Twenty four hour ambulatory blood pressure monitoring (24-H ABPM) plays an important role in the management of hypertensive patients. The aim of our study was to determine the frequency of seven known adverse prognostic features in an ambulatory assisted hypertensive patient population.
Methods: The study included all the 957 hypertensive patients with a performed 24-H ABPM, examined in the 2008–2011 period in a preventive ambulatory cardiology system. The studied adverse prognostic features were: daytime systolic blood pressure (BP) >140 mmHg, daytime diastolic BP >90 mmHg, nighttime systolic BP >125 mmHg, nighttime diastolic BP >75 mmHg, nocturnal dipping <10%, early morning hypertension >140/90 mm Hg, pulse pressure >53 mm Hg. Patient data were introduced in an integrated patient data management system as an electronic health record. The frequency of adverse prognostic features was compared in type 2 diabetic versus non-diabetic patients, and in patients with or without manifest cardiovascular complications (ischemic heart disease, stroke, lower extremity arterial disease).
Results: The frequency of the studied adverse prognostic features was as follows: high daytime systolic BP 38.1%, high daytime diastolic BP 21.4%, high nighttime systolic BP 45.5%, high nighttime diastolic BP 31.3%, absent nocturnal dipping 59.9%, morning hypertension 33.6%, high pulse pressure 51.5%, morning surge 5.1%. A large proportion of subjects (86.2%) had one or more adverse features reported on the 24-H ABPM.
Conclusions: In clinical practice there is a frequent association of multiple adverse prognostic features of ambulatory blood pressure monitoring. The presence of some prognostic features is associated with the presence of diabetes, stroke history, ischemic heart disease or lower extremity arterial disease.

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Contribution of Neonatal Ultrasound Screening to Decrease Median Age at Diagnosis of Congenital Renal Anomalies

Introduction: Considering the fact that approximately 10% of children are born with various, mild or severe anomalies of the urinary system, and most of them remain asymptomatic until the development of complications, early diagnosis plays a crucial role in the prognosis of these patients. In the era of ultrasonography, an early diagnosis means a diagnosis established during intrauterine life, but considering the multiple traps of prenatal diagnosis, neonatal screening of these malformations has a major importance.
Material and methods: We have performed a retrospective study of the cases with congenital malformations of the urinary system, admitted to the 2nd Pediatric Clinic of Tîrgu Mureș, between January 2003 and December 2008. Concidering that between 2006 and 2008 neonatal ultrasound screening has been performed for these malformations, the patients were divided into two groups based on the year of admission. Establishment of the median age of patients with renourinary malformations was considered an important factor as it was aimed at emphasizing the role of neonatal screening in the early diagnosis of these anomalies.
Results: The mean age of the patients at the time of diagnosis of congenital malformation of the urinary system in case of the 2003–2005 study group was 4.82 years. Using an ultrasound screening in the neonatal period, the mean age at the time of diagnosis of congenital malformations of the urinary system dropped to 50.9 months compared to 57.9 months calculated for the three years when this screening has not been performed.
Conclusion: In the absence of a neonatal ultrasound screening of congenital malformations of the urinary system, the diagnosis of these anomalies is established late, in most cases only at the time of occurrence of complications

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